Abstract
Aims
Current antibiotic treatment strategies for prosthetic joint infection (PJI) are based mostly on observational retrospective studies. High-quality data from prospective cohorts using identical treatment strategies may improve current clinical practice. We developed a regional network of collaborating hospitals and established a uniform treatment protocol. Data from all patients diagnosed with a PJI are prospectively registered in a an online database. With this quality registry we aim to study the outcome of antibiotic and surgical strategies while adhering to a pre-established treatment protocol.
Methods
A working group of orthopaedic surgeons, infectious disease specialists and microbiologists was established. The working group reached consensus on definition of PJI and a uniform treatment protocol, based on current guidelines and expert-based clinical experience. A website was built to communicate information to colleagues and patients (www.protheseinfectie.nl). In each participating hospital weekly multidisciplinary meetings were started to discuss all PJI cases. All patients are included in an online quality registry and followed for at least two years. We aim to enroll >600 patients with a knee or hip PJI. Research will focus on the duration of antibiotic treatment, antibiotic suppressive therapy and comparison of different oral antibiotic treatment strategies in relation to successful treatment outcomes.
Results
Currently, four regional hospitals are included in the partnership. Multidisciplinary meetings have lowered the threshold to discuss patients, and the adherence to the PJI treatment protocol has improved steadily. Complicated cases are discussed between colleagues from collaborating centers. The collaboration has been perceived as very successful by the participating hospitals. Since 2015, over 300 patients have been included, of whom 52% were male. In 26%, PJI occurred after revision surgery. Staphylococcus aureus was involved in 25% of cases, coagulase-negative Staphylococci in 23%, Streptococci in 13% and Gram-negative micro-organisms in 15%.
Conclusions
In this project, collaboration between different medical specialties through multidisciplinary meetings was the key to the improvement of patient care The regional collaborative project led to the implementation of a uniform treatment protocol for PJI. With this prospective project we aim to improve patient care by providing evidence for optimal antibiotic and surgical strategies for PJI. Ideally, countries should have hospital networks and a uniform method of data collection to make it easy to share data for scientific research.
